ABSTRACT
There is a high level of evidence that parental presence during induction of anesthesia in children does not lead to a reduction of fear and better cooperation of the child. However, pediatric anesthetists often encounter the request of parents to be present during the induction of anesthesia which is current practice in many countries. This article explains the grounds and the premises for this practice and describes those factors which might be important to support parental presence during induction of anesthesia in children. Some practical advice and tips on how parental presence in the clinic can be practically implemented are given at the end of the article.
Subject(s)
Anesthesia/psychology , Parents/psychology , Adult , Anxiety/etiology , Anxiety/psychology , Child , Child, Preschool , Humans , Parent-Child Relations , Preoperative CareSubject(s)
Hypnotics and Sedatives , Midazolam , Preanesthetic Medication , Anesthesia/adverse effects , Anti-Anxiety Agents/therapeutic use , Cell Death/drug effects , Child , Humans , Hypnotics and Sedatives/adverse effects , Midazolam/adverse effects , Preanesthetic Medication/adverse effects , Preoperative CareABSTRACT
Paediatric craniofacial surgery (pCFS) regularly requires transfusion of packed red blood cells (pRBC). In this clinical pilot study two different transfusion regimens were prospectively compared concerning pRBC transfusions, postoperative bleeding and other clinical parameters. Thirty infants (aged < 12 months) scheduled for pCFS were assigned to receive fresh frozen plasma (FFP-group, n = 15) or 5% human albumin (HA-group, n = 15) during the entire surgical procedure. Perioperative amounts of pRBC, postoperative bleeding, major complications, duration of stay in the intensive care unit and overall hospital stay were compared. Differences in pRBC transfusions, postoperative bleeding, and duration of intensive care unit stay were not significant and no major complications occurred in either group. A significantly shorter overall hospital stay was observed in favour of the FFP-group. Volume replacement during pCFS can be safely performed with both applied protocols. Our data do not demonstrate a major advantage for FFP use, but further evaluation is necessary.
Subject(s)
Craniosynostoses/surgery , Intraoperative Care/methods , Plasma Exchange/methods , Plasma , Serum Albumin/administration & dosage , Female , Humans , Infant , Length of Stay , Male , Pilot Projects , Postoperative Complications , Prospective StudiesABSTRACT
Airway management in newborns, infants, and children is a challenge to anesthesia practitioners due to the particular anatomic and physiological characteristics. The larynx is positioned more cephalad, the occiput is protuberant, and the neck is short, which makes a special position for anesthesia induction necessary. The high respiratory frequency due to high oxygen demand and carbon dioxide production has to be taken into consideration during manual as well as mechanical ventilation. Different devices are available for airway management. Simple mask ventilation can be improved by a Wendl tube. The classic laryngeal mask can be recommended as a safe airway device in many indications, specifically in children with an upper respiratory airway infection. If intubation is indicated, an optimal size and position of the endotracheal tube has to be provided. Fiberoptic endotracheal intubation is recommended if a difficult airway is known or anticipated due to a craniofacial syndrome.
Subject(s)
Anesthesia, Inhalation , Intubation, Intratracheal , Respiration, Artificial , Airway Obstruction/therapy , Child , Child, Preschool , Fiber Optic Technology , Humans , Infant , Infant, Newborn , Laryngeal Masks , Larynx/anatomy & histology , Respiratory Mechanics , TracheotomyABSTRACT
We have developed a modern strategy for the anaesthetic management of the pediatric airway using anaesthetic drugs such as sevoflurane, propofol, mivacurium and remifentanil, together with new techniques including the laryngeal mask. This strategy provides optimal conditions for the examiner and maximum safety for the pediatric patient. The endoscopic investigation of pediatric airways has become important for the diagnosis and treatment of many pediatric diseases, and is often performed with the support of a pediatric anaesthetist. Important indications include acute and chronic stridor, chronic obstructive airway disease, mucoviscidosis and foreign body aspiration. The best and safest techniques are outlined depending on the clinical situation, and the most frequent complications are discussed, e.g. hypoxaemia, respiratory arrest, laryngospasm, bronchial obstruction, pneumothorax and overdosing of local anaesthetic agents.
